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The  Future  of  Medicine  in  the 
United  States1 

It  is  not  fatuous  optimism  to  believe  that  this  country  is  the 
most  fitting  place  for  the  future  center  of  medicine,  nor  is  believ- 
ing this  to  sin  on  the  side  of  vain  glory.  However  much  the  idea 
may  seem  to  be  the  product  of  over-ardent  patriotism,  looking  at 
it  earnestly,  we  shall  see  it  is  nothing  of  the  kind.  It  makes  one 
of  the  many  demands  upon  us  to  prepare  ourselves  now  for  the 
even  greater  struggle  after  the  war.  To  us  it  comes  as  a  summons 
to  a  duty  we  should  not  neglect. 

The  reasons  for  this  are  many  and  easy  to  discern.  During  the 
past  four  years  war  has  swept  the  world  with  a  power  to  destroy 
more  complete  than  ever  before  in  history.  If  it  revealed  a 
ruthless  plan  which  menaced  the  race,  at  the  same  time  it  exposed 
a  nation  which  has  lost  its  mental  bearings.  The  Germans  for 
many  years  have  been  laboring  under  a  delusion  of  grandeur. 
They  have  been  obsessed  by  the  conviction  of  their  own  racial 
superiority.  This  eventually  led  to  the  paranoid  idea  of  world 
dominion.  It  has  been  part  of  their  unfortunate  heritage  as  a 
people  to  believe  in  the  righteousness  of  might.  They  were  even 
more  unfortunate  because  they  have  long  been  under  the  influence 
of  rulers  who,  by  cultivating  this  belief,  exploited  a  national 
weakness.  Their  most  serious  misfortune  is  their  present  ruler. 
Prepared  for  the  coming  of  a  war-lord  by  their  successful  aggres- 
sion in  the  Franco-Prussian  war,  the  German  people  were  quickly 
infected  by  the  expansive  ideas  of  the  new  ruler.  He  on  his  part 
at  once  began  to  weld  the  old  fetters  of  feudalism,  and  soon  had  so 
controlled  public  opinion  that  the  German  standards  of  judgment 
in  morals,  religion,  science,  art,  and  politics  were  no  longer  matters 

1  The  annual  address  at  the  opening,  September,  1918,  of  the  College  of  Physicians 
and  Surgeons.  The  corresponding  address  a  year  ago,  on  the  opportunities  of  thegreat 
war  itself,  is  in  the  Quarterly  for  January,  191 8  (xx,  48) . 


302  Columbia  University  Quarterly  [October 

of  independent  decision.  Our  former  ambassador  to  Berlin,  Dr. 
David  Jayne  Hill,  epitomizes  the  tendencies  in  Germany  when  he 
says:  "Like  money  put  out  at  usury,  power  in  government 
grows  with  astonishing  rapidity.  When  it  is  both  concentrated 
and  undisputed,  as  in  the  case  of  imperial  absolutism,  it  soon  be- 
comes irresistible.  No  better  example  of  this  rapid  centralization 
of  power  can  be  found  in  history  than  the  growth  of  Kaiser  William 
IPs  personal  control  not  only  of  German  action,  but  of  German 
thought."  In  his  instructive  reference  to  the  Verdun  Prize  this 
celebrated  student  of  Germany  gives  a  striking  illustration  of  the 
method  by  which  the  Kaiser  gained  control  over  the  universities. 
The  prize  referred  to  was  annually  awarded  for  the  most  meri- 
torious historical  work  of  the  year.  In  1894  the  Academy  of  Berlin 
unanimously  awarded  it  to  the  famous  historian  Von  Sybel  for  his 
work  on  the  'Foundation  of  the  New  German  Empire'.  To  the 
amazement  of  all,  the  young  Kaiser  drew  his  pen  through  the 
name  of  Von  Sybel,  awarding  the  prize  to  a  Heidelberg  writer  for 
an  inferior  work  on  the  Great  Elector,  one  of  the  Kaiser's  ances- 
tors. Gradually,  under  such  influence,  the  faculties  of  the  univer- 
sities and  schools  came  to  wear  the  King's  coat,  for  in  this  way 
only  was  advancement  possible.  But  it  did  not  stop  with  the  sub- 
ordination of  learning.  Soon  it  extended  to  the  press  and  the 
church.  In  time,  baited  by  the  avaricious  expectations  of  German 
world-dominion,  commerce  and  finance  came  into  the  net,  until  at 
length  allegiance  to  the  Kaiser  on  the  farm  and  in  the  factory,  in 
the  banking  house  and  on  the  sea,  meant  power  to  the  arm  that 
was  to  strike  the  swift,  overwhelming  blow  for  alluring  plunder.  In 
this  attitude  we  see  them  posed  to  strike  for  the  predestined  day, 
infector  and  infected  alike  charged  with  the  same  venom,  filled 
with  Prussian  lust  for  power. 

The  blow  that  fell  was  neither  swift  nor  powerful  enough.  It 
did,  however,  strip  off  the  mask  and  finally  arrayed  against  the 
transgressors  the  outraged  humanity  of  most  of  the  world.  In  this 
way  two  great  forces  have,  for  more  than  four  years,  been  engaged 
in  a  process  of  irreparable  destruction.  Nearly  every  line  of 
human  activity  has  been  turning  its  product  into  the  vortex  until 
the  waste  in  all  materials  and  in  intellect  has  become  stupendous. 


191 8]  The  Future  of  Medicine  in  the  United  States  303 

In  the  end,  Germany,  vaunted  the  most  efficient  of  nations,  has 
shown  herself  to  be  the  most  destructive  organization  in  history. 
Through  forty  years,  while  establishing  German  supremacy  in 
the  pursuits  of  peace,  the  government  built  parallel  to  this,  and 
deliberately  planned  to  use,  the  destroying  engine  of  its  military 
power.  This  power  has  swept  German  commerce  from  the  seas, 
decimated  her  manhood,  filled  her  cities  with  the  maimed  and 
blind,  prostrated  her  science  and  industries,  and  brought  her  to 
spiritual  as  well  as  financial  bankruptcy.  Nor  is  this  all.  Had 
the  ruin  been  confined  to  Germany  alone,  the  evil  record  might 
have  been  less  onerous  to  bear.  But  the  destruction  which  Ger- 
many begot  has  drawn  all  of  the  other  productive  nations  into 
the  disaster.  Their  wealth  and  man-power,  their  intellectual 
efforts  and  enterprises  which  go  to  make  up  civilization,  have  been 
diverted  into  the  conflagration.  Years  of  readjustment  and 
recuperation  lie  ahead,  years  of  we  know  not  what  extreme  test 
upon  our  faith,  our  courage,  and  our  tenacity  to  adhere  firmly  to 
the  right.  These  are  the  times  for  which  we  must  now  begin  to 
prepare  ourselves. 

There  can  be  no  doubt  that  the  struggle  in  Europe  will  be 
severe.  The  entire  effort  of  every  European  state  must  be  con- 
centrated upon  the  rehabilitation  of  the  essentials  of  life.  The 
higher  pursuits  of  civilization  must  for  the  time  at  least  stand 
aside,  or  bend  their  energy  to  the  simpler  purposes.  The  security 
and  plenty  upon  which  German  medical  science  grew  to  be  the 
commanding  figure  in  the  world  of  medicine  have  gone.  Not  for  a 
long  time  will  the  Germanic  capitals  be  the  centers  of  medical 
learning  which  they  have  been  in  the  past.  This  distinction  must 
pass  into  other  keeping.  France,  henceforth  the  symbol  of  heroic 
sacrifice  and  salvation,  has  given  nearly  all  she  had,  and  being 
impoverished  by  the  noble  gift,  needs  time  to  replenish  her  re- 
sources. England,  the  bulwark  of  civilization  throughout  the 
struggle,  has  stripped  her  empire,  and  for  years  to  come  will  be 
handicapped  in  maintaining  and  advancing  science.  This  is 
particularly  true  in  medical  science ;  for  Great  Britain  early  in  the 
war  encouraged  the  mobilization  of  the  entire  medical  profession, 
and  permitted  medical  students  to  serve  with  the  colors,  in  this 


304  Columbia  University  Quarterly  [October 

way  depriving  herself  of  a  large  annual  increment  to  the  medical 
ranks.  Whatever  handicaps  we  may  labor  under,  due  to  our 
present  or  future  sacrifices,  we  shall  inevitably  occupy  the  point 
of  vantage  in  this  regard  as  well  as  a  position  of  responsibility. 
We  can  understand  how  it  must  be  our  duty  here  in  America  to 
carry  on  the  constructive  advance  work  in  medicine  while  the 
nations  of  Europe  struggle  through  their  period  of  reconstruction. 

But  there  is  a  still  more  cogent  reason  why  we  should  accept 
this  responsibility,  namely,  because  we  are  now  ready  and  able 
to  take  the  place  we  should  hold  in  medicine.  The  war  has  brought 
about  far-reaching  changes  in  the  country.  It  has,  as  Lord  French 
says,  made  a  nation  of  us.  Under  the  great  leadership  of  President 
Wilson  the  whole  essence  of  our  destiny  has  been  crystallized,  and 
we  move  forward  unified  by  a  national  consciousness,  no  longer 
North  or  South,  or  East  or  West,  but  one  people  irresistible  in 
the  resolve  to  accomplish  our  purpose.  The  war  has  brought 
about  far-reaching  changes  in  medicine  because  we  have  gained  a 
national  consciousness. 

The  country  no  longer  regards  medicine  merely  as  a  learned 
profession,  but  is  coming  to  consider  it  one  of  the  essential  indus- 
tries. Sound  public  health  is  a  necessary  element  in  the  will  to 
victory.  The  civil  population  unduly  enfeebled  by  disease  or 
discouraged  by  neglect  cannot  be  expected  to  support  a  winning 
army.  All  signs  give  assurance  that  the  government  in  its  wisdom 
will  provide  adequate  medical  attention  for  the  people,  prevent 
relaxation  in  the  safeguards  against  epidemics,  and  restrict  the 
spread  of  disease  to  the  limits  normal  in  peace-time.  In  another 
critical  relation  the  efforts  of  the  medical  profession  have  become 
indispensable  to  final  success.  The  vast  detail  of  the  health  of  an 
army  is  in  the  hands  of  its  medical  corps.  Failure  here  is  almost 
as  serious  as  defeat  by  the  enemy.  The  selection  of  the  fit  and 
rejection  of  the  unfit,  the  supervision  of  sanitation,  the  prevention 
of  disease,  the  stamping  out  of  epidemics,  the  early  detection  of 
the  physically  and  mentally  unstable,  to  say  nothing  of  adequate 
care  and  reconstruction  of  the  sick  and  wounded,  are  matters  of 
vital  importance  to  troops  in  the  field.  The  war  has  shown  us  the 
possibilities  of  medicine  carried  out  intensively  in  all  its  branches. 


1918]  The  Future  of  Medicine  in  the  United  States  305 

From  these  lessons  we  have  gained  more  cohesion  as  a  profession. 
We  understand  now  more  fully  our  obligation  to  civil  communi- 
ties; we  recognize  our  opportunities  for  greater  public  service 
and  see  the  value  in  a  more  complete  system  whose  development 
will  better  safeguard  the  public  health.  In  attributing  these 
changes  to  the  war,  it  is  but  just  to  indicate  that  they  are  in 
large  part  due  to  the  efforts  of  Surgeon  General  Gorgas.  He 
has  given  us  a  demonstration  of  the  efficacy  of  national  or- 
ganization in  medicine.  The  organization  of  his  own  depart- 
ment is  one  of  the  real  achievements  of  the  war.  It  is  widely 
admitted  that  the  Medical  Corps  of  the  United  States  Army 
is  without  peer.  The  public  knows  too  little  of  its  develop- 
ment and  management  to  appreciate  the  efficiency  of  one  of  the 
most  potent  forces  fighting  for  civilization  today.  Over  twenty- 
five  thousand  physicians  have  been  called  in  from  all  branches  of 
private  practise  and  given  special  training  for  some  particular 
work  in  the  army.  Provision  has  been  made  for  the  psychological 
testing  and  grading  of  troops  in  training;  specialists  have  been 
developed  for  testing  the  flight  capacities  of  aviators.  Every 
department  and  sub-department  in  medicine  is  manned  by  phy- 
sicians who  have  had  special  courses  of  intensive  training.  Each 
of  the  larger  groups  of  diseases  is  provided  with  its  special  base 
hospital,  and  plans  are  already  perfected  for  the  rehabilitation  of 
the  maimed  and  blind  who  unfortunately  will  return  in  increasing 
numbers  to  our  shores.  In  a  word,  every  contingency  that  a  far- 
seeing  intelligence  might  anticipate  has  been  provided  for  in  a 
scientific  manner.  With  an  organization  in  all  branches  of  the 
war  department  such  as  General  Gorgas  has  built  up,  the  United 
States  Army  must  certainly  be  invincible. 

Alive  to  the  significance  of  our  position,  we  recognize  that 
American  medicine  can  no  longer  be  an  overseas  province  on  the 
medical  map.  We  are  ready  to  make  it  what  it  should  be.  Our 
tradition  leads  us  to  feel  that  we  shall  succeed.  Our  practical 
instinct  compels  us,  however,  to  take  stock  of  our  qualifications. 
As  to  one  of  our  assets  there  can  be  no  dispute.  American  medi- 
cine is  supreme  in  surgery.  In  this  most  direct  practical  handi- 
craft of  the  healing  art,  it  is  probable,  we  have  no  equals.    Ameri- 


306  Columbia  University  Quarterly  [October 

can  surgery  has  won  its  repute  not  alone  for  its  ingenuity  and 
sound  adherence  to  fundamental  principles,  but  quite  as  much 
through  the  brilliancy  of  its  technic  and  enterprise.  It  has 
produced  a  surprisingly  large  number  of  surgeons  noted  for  their 
exceptional  skill  in  general  and  highly  special  regional  procedure. 
The  number  of  these  is  still  growing.  In  fact,  no  other  country 
possesses  so  many  thoroughly  trained  surgeons  who  may  be  con- 
sidered competent  to  assume  the  responsibilities  of  major  opera- 
tive work.  The  dominant  position  of  America  in  surgery  is  wit- 
nessed by  the  steadily  growing  influx  of  foreign  surgeons  in  the 
past  few  years  to  the  famous  operating  amphitheaters  of  this 
country.  Our  own  surgeons  understand  that  they  have  become 
the  instructors  in  their  branch. 

Another  valuable  factor  ready  to  our  hand  is  the  diagnostic 
clinic,  or  group  idea  in  diagnosis  and  practise.  This  is  essentially 
an  American  conception,  and  its  successful  application  as  a 
scientific  method  for  the  practise  of  medicine  is  an  accomplishment 
in  which  we  have  a  just  national  pride.  Not  only  is  it  the  most 
efficient  way  of  bringing  the  ailments  of  each  individual  patient 
under  complete  medical  review  through  examinations  by  experts 
in  each  particular  department,  but  it  confers  a  further  benefit  upon 
the  patient  by  furnishing  the  best  medical  advice  in  the  most 
economical  way.  To  the  physicians  engaged  in  the  work  it  serves 
as  a  mutual  inspiration  and  a  constant  incentive. 

In  the  matter  of  equipment  we  are  rapidly  increasing  the  num- 
ber of  modern  hospitals  throughout  the  country.  These  institu- 
tions have  the  advantages  of  modern  management,  which  con- 
ceives of  the  hospital  as  an  educational  factor  as  well  as  a  place  to 
care  for  the  sick.  The  idea  is  becoming  more  generally  accepted 
that  a  hospital,  especially  in  large  centers,  which  has  no  teaching 
facilities  does  not  discharge  its  full  duty  to  the  public.  The  per- 
sonnel of  the  profession  is  fortunate  in  its  admixture  of  nationali- 
ties and  races.  This  cannot  fail  to  be  ultimately  advantageous, 
as  it  tends  to  catholicity  of  view-point  and  furnishes  a  variety  in 
methods  of  approach. 

The  American  system  of  medical  education  is  conspicuous 
among  our  assets.    It  has  an  efficient  organization  which  under  the 


1918]  The  Future  of  Medicine  in  the  United  States  307 

guidance  of  State  boards  and  certain  large  national  associations 
has  effected  a  standardization  of  medical  instruction.  This  gives  a 
well-rounded  training  in  all  branches  of  medicine.  The  fifth 
hospital  year,  already  instituted,  is  designed  to  furnish  a  finishing 
course  in  practical  work.  During  this  period  the  student  will  live 
in  the  hospital,  gaining  clinical  experience  under  the  direction  of 
resident  instructors.  The  establishment  of  separate  faculties  to 
increase  the  opportunities  and  requirements  of  post-graduate 
instruction  in  medicine  is  receiving  serious  consideration.  Full- 
time clinical  professorships  as  proposed  will  materially  advance 
the  interests  of  research  in  the  clinical  branches  and  provide  more 
time  for  teaching.  Medical  research  has  had  an  unprecedented 
growth  in  recent  times,  as  evidenced  by  the  development  of 
special  institutions  for  the  intensive  study  of  the  human  body  and 
its  diseases.  Notable  among  these  are  institutes  for  the  investiga- 
tion of  cancer,  tuberculosis,  mental  disorders,  the  development  of 
the  body,  the  anatomy  of  the  brain,  and  general  experimental 
medicine.  In  connection  with  these  institutes  the  opportunities 
for  post-graduate  teaching  have  been  much  enhanced. 

We  must  not,  however,  neglect  the  other  side  of  the  question. 
We  have  our  defects.  The  most  obvious  of  these,  perhaps,  is  that 
we  have  permitted  our  vision  to  become  near-sighted  and  locally 
introspective.  Because  of  this  limited  view,  we  have  gained  no 
sense  of  the  possibilities  and  proportion  of  our  mission;  it  would 
even  seem  that  we  had  no  realization  of  a  mission  at  all.  A  com- 
placent isolation  of  the  larger  medical  centers  has  cultivated  an 
exclusiveness  which  does  not  promote  mutual  understanding,  or 
inspire  the  confidence  which  engenders  the  spirit  of  progress. 
There  has  been  in  consequence  a  lack  of  broad  conception  and 
comprehensive  organization.  Our  natural  impetuosity,  our  desire 
for  quick  results,  have  made  us  intolerant  of  delay  and  often  hasty 
where  patience  is  more  needed  as  a  commodity  than  as  a  virtue. 
We  have  had  too  little  esteem  for  our  own  achievements  and  an 
overweening  regard  for  foreign  work,  especially  of  German 
stamp.  This  is  all  the  more  discomfiting  since  the  quality  of 
German  production  has  fallen  off  in  the  past  fifteen  or  twenty 
years.    It  may  now  be  seen  how  much  of  the  mass  of  German  medi- 


308  Columbia  University  Quarterly  [October 

cal  literature  was  part  of  the  ambitious  scheme  of  exploitation 
which  has  sapped  so  many  good  things  of  their  worth  and  sincer- 
ity. 

These  defects,  although  serious,  should  not  retard  us.  Such  is 
not  the  American  character,  as  we  know  from  recent  examples. 
When  the  call  for  men  came  from  France,  our  response  was  not 
the  difficulty  of  drafting,  equipping,  and  transportation;  but, 
putting  all  obstacles  aside,  we  have  sent  an  army  which  is  well  on 
its  way  to  final  victory.  Let  us  be  convinced  that  there  is  some- 
thing which  must  be  done,  and  its  accomplishment  is  assured. 
When  the  conviction  is  established  that  we  owe  this  duty  to 
medicine,  America  will  indeed  become  a  new  medical  center. 

It  may  be  that  the  first  step  to  secure  this  end  will  be  a  federa- 
tion of  American  medical  colleges  and  institutes.  A  council  repre- 
sentative of  these  institutions  would  cooperate  in  the  interests  of 
medical  education  and  medical  science.  If  the  satisfactory 
diagnosis  of  the  individual  patient  requires  a  group  of  diagnosti- 
cians, how  much  more  do  the  profound  and  baffling  problems  of 
medicine  demand  large  groups  of  special  workers  for  their  solution ! 
Coordination  of  investigation  might  be  carried  to  a  high  level  of 
efficiency  by  this  intensive  cooperation  in  medical  research.  The 
distinctive  advantages  of  each  medical  center  would  not  then  be 
matters  of  local  reputation,  but  part  of  the  national  endowment 
in  medicine.  The  large  cities  and  the  other  noted  medical  lo- 
calities, making  their  contributions  to  a  common  cause,  would 
attract  to  this  country  a  vast  number  of  the  seekers  for  medical 
knowledge  who  formerly  would  have  been  found  in  the  capitals 
of  Europe. 

It  would  be  difficult  to  estimate  the  impetus  which  such  a 
combination  would  impart  to  the  newer,  important  trends  in 
medicine.  The  influences  of  civic  interest  are  becoming  con- 
tinually stronger  because  medical  supervision  is  proving  itself 
indispensable  in  many  fields  of  community  life.  The  well-trained 
physician  of  the  future  must  be  versed  in  the  requirements  of 
public  service. 

Preventive  medicine  particularly  is  destined  to  undergo  much 
expansion.    To  its  many  present  activities  others  equally  neces- 


1918]  The  Future  of  Medicine  in  the  United  States  309 

sary  will  be  added.  Among  these  might  be  mentioned  the  need  of 
medical  registration  for  the  detection  of  disease  in  its  incipience. 
Those  connected  with  draft  exemption  boards  have  been  astonished 
at  the  inroads  into  possible  military  effectives  made  by  preventable 
diseases  or  disorders  curable  in  early  life. 

Industrial  medicine  will  soon  have  a  field  of  its  own.  The 
health  of  operatives  is  calculated  as  an  essential  of  efficiency,  and 
medical  departments  have  already  been  installed  in  a  number  of 
large  corporations. 

Public  mental  hygiene  is  an  urgent  national  problem  which 
must  engage  medical  attention  more  seriously  in  the  future. 
The  significance  of  insanity  as  an  economic  loss  will  be  realized 
by  the  fact  that  one-third  of  the  entire  budget  of  New  York  State 
is  annually  appropriated  for  the  care  of  the  insane.  Under  the 
guidance  of  the  National  Committee  for  Mental  Hygiene  a  nation- 
wide investigation  is  being  conducted  in  order  to  determine  the 
prevalence  and  causes  of  insanity.  The  Committee  has  already 
done  much  to  improve  the  care  of  the  insane,  and  has  stimulated  a 
real  interest  in  the  effort  to  reduce  the  prevalence  of  mental 
disorders.  Feeble-mindedness  as  a  burden  to  the  community  has 
assumed  such  proportions  as  to  necessitate  the  appointment  of  a 
special  commission  for  its  management  in  this  state.  The  govern- 
ment attaches  such  importance  to  this  problem  that  it  has  called 
one  of  the  most  distinguished  physicians  of  this  country  to  the 
chairmanship  of  the  Committee. 

The  necessity  of  medical  cooperation  in  court  and  prison  mat- 
ters has  become  apparent.  To  distinguish  between  the  feeble- 
minded, a  psychopathic  delinquent  on  the  one  hand,  and  the 
criminal  on  the  other,  to  differentiate  between  the  necessity  of 
therapeutic  and  of  punitive  measures  in  each  case,  and  to  study 
the  pathological  factors  in  the  development  of  the  criminal  are 
necessary  functions  of  the  state. 

If  the  country  is  to  avail  itself  of  the  obvious  advantages  of 
universal  military  training  after  the  war,  military  medicine  must 
be  still  further  developed  in  the  colleges.  It  seems  advisable  that 
permanent  courses  in  military  medicine  be  introduced  into  the 
curriculum  of  medical  schools. 


310  Columbia  University  Quarterly  [October 

These  higher  requirements  of  medicine  make  unusual  demands 
upon  those  of  us  who  are  working  in  this  field  today.  Yet  only 
as  we  devote  ourselves  with  intelligence  and  redoubled  energy  to 
our  duties  will  it  be  possible  for  us  to  reach  the  object  to  which  we 
seem  destined  by  circumstance.  In  so  large  an  undertaking  the 
work  is  not  ours  alone.  The  nation  already  begins  to  understand 
our  purposes.  When  it  appreciates  the  full  importance  of  our 
relation  to  its  welfare,  we  shall,  as  a  recognized  economic  necessity, 
have  its  liberal  support.  It  is  especially  necessary  in  all  parts  of 
the  country  that  those  who  have  the  interests  of  medical  develop- 
ment in  their  keeping  shall  make  their  efforts  decisively  construc- 
tive. In  the  future,  no  doubt,  a  reliable  index  to  the  intelligence 
of  a  community  will  be  the  degree  to  which  it  has  mobilized  its 
medical  resources. 

If  our  eyes  seem  fixed  on  the  future,  it  is  because  we  understand 
that  although  civilization  must  be  defended  against  the  ravages 
of  war,  it  owes  its  continuance  and  growth  to  the  security  of 
peace.  We  remember  at  what  cost  we  delayed  in  preparing  for 
war.  We  are  loth  to  make  the  same  mistake  again  and  would 
prepare  in  time  for  the  severe  burdens  after  the  conflict  is  over. 
Education,  the  surest  guarantee  of  social  stability,  should  be  the 
subject  of  our  most  earnest  attention.  How  much  the  events  of 
the  war  have  converted  public  opinion  in  England  to  the  belief 
that  the  future  of  that  nation  depends  upon  the  better  education 
of  the  coming  generation,  has  been  shown  by  the  reception 
accorded  the  Fisher  Education  Bill  in  the  House  of  Commons  and 
in  the  country.  The  cardinal  features  of  this  bill  are  the  continua- 
tion of  elementary  education  for  all  children  and  the  establish- 
ment of  secondary  education  for  girls  and  boys  on  a  national 
basis.  It  also  provides  increased  emolument  and  pensions  for 
teachers,  in  this  way  aiming  to  bring  into  the  teaching  profession 
and  retain  there  the  brains  of  the  country. 

We  should  cooperate  with  the  Government  to  prevent  any 
unnecessary  interruption  in  the  work  of  our  schools  and  univer- 
sities, and  urge  that  all  institutions  of  science  and  advanced  learn- 
ing shall  be  stimulated  rather  than  curtailed  in  their  efforts.  "Win 
the  war  first,"  says  Lloyd  George;  "but  when  peace  comes  I  don't 


19 1 8]  The  Future  of  Medicine  in  the  United  States  311 

want  the  nation  to  be  taken  unawares."  There  must  be  healthier 
conditions  in  the  workshops  and  more  attention  to  the  schools. 
There  are  disturbing  symptoms  all  over  Europe  which  those  at 
home  will  be  wise  to  note  and  provide  against.  "Let  us  take  heed 
in  time,"  he  continues,  "and  if  we  do,  we  shall  enjoy  settled  weather 
for  the  great  harvest  which  is  coming  when  the  fierce  heat  of 
summer  now  beating  upon  us  in  this  great  war  is  over  and  past." 
Let  us  in  America  also  take  heed  of  the  demands  for  national 
health,  both  economic  and  intellectual;  and,  being  sure  that  the 
lamps  of  learning  are  the  lights  of  the  future,  let  us  keep  them 
bright. 

It  is  not  in  medicine  alone  that  we  are  looking  to  the  future. 
An  era  of  expansion  in  all  our  activities  and  in  our  sphere  of  in- 
fluence is  in  sight.  The  day  to  which  we  look  has  no  taint  of 
avarice ;  for  the  motives  which  raised  the  nation  to  a  high  place 
of  esteem,  the  sacrifices  which  have  ennobled  the  republic,  will 
increase  our  capacity  of  service  to  mankind.  Again,  as  in  our 
past,  after  the  wounds  of  a  great  war,  that  day  for  us  is  to  be  one 
of  justice  and  without  malice.  Every  calling  has  its  allotted  task. 
The  obligation  of  the  medical  profession  is  clear,  and  some  portion 
of  it  rests  on  each  one  of  us.  The  materials  are  ready  and  only 
await  assembling  for  the  creation  of  a  new  Mecca  of  medicine. 

Frederick  Tilney 


Rumania  and  the  War1 

Tswo  years  ago,  when  I  was  in  London,  I  saw  in  a  newspaper  a 
sketch,  representing  a  newspaper  boy  in  1935  crying  'Rumania 
coming  in'.  That  sketch  depicted  sarcastically  the  anxiety  and 
the  puzzled  state  of  mind  of  the  public  as  to  the  attitude  of 
Rumania.  From  19 14  until  19 16  Rumania  was  the  political 
sphinx  of  the  time.  Is  Rumania  to  come  into  the  war?  On  whose 
side,  and  when?  Why  has  she  not  yet  come  in?  These  questions 
remained  unanswered.  No  one  was  able  to  say  anything  definite. 
Later  on,  long  before  1935,  Rumania  did  enter  the  war  on  the 
side  of  the  Allies.  After  some  ephemeral  successes  at  the  begin- 
ning, when  her  sons  after  three  centuries  of  waiting  since  the  time 
of  Michael  the  Brave  entered  again  into  Transylvania,  the  calvary 
of  her  misfortunes  began:  the  loss  of  Dobrudja,  the  retreat  in 
Transylvania,  the  loss  of  Wallachia,  hunger,  and  exanthematic 
typhoid.  Instead  of  the  enthusiasm  which  greeted  the  entry  of 
Rumania  into  the  war,  a  sort  of  disillusionment  and  disappoint- 
ment was  felt  in  the  West,  where  'failure'  was  the  only  word  used 
of  Rumania.  The  long  awaited  ally  on  whom  so  many  hopes  had 
been  built  had  become  a  burden  difficult  to  support  and  a  trouble- 
some companion  in  the  fight.  Only  quite  lately,  during  the  sum- 
mer of  191 7,  after  the  Homeric  battles  of  Mareshti  and  Mara- 
sheshti,  when  a  good  many  allied  officers  and  soldiers  had  the 
opportunity  to  be  eye-witnesses  of  the  bravery  of  the  Rumanian 
soldiers,  public  opinion  in  the  West  immediately  altered  its  ideas 
and  sentiments  toward  Rumania.    And  now  after  the  Russian 

1 A  Rumanian  physician,  member  of  the  Parliament,  and  representative  of  Rumania  at 
the  Congress  of  Rome  last  spring,  interprets  here  not  only  a  difficult  chapter  of  the  war, 
but  the  international  aspects  of  Rumanian  political  ideals.  Through  the  courtesy  of 
Professor  A.  M.  Lybyer  of  the  University  of  Illinois,  two  statistical  notes  have  been 
added  where  reports  appear  to  differ.  These  corrections  of  detail,  however,  and  others 
that  might  be  made  are  the  less  important  since  the  peculiar  value  of  this  article  is  farv 
less  in  its  review  of  facts  than  in  its  interpretation  of  national  tendencies  and  aspirations.  ^ 
A  comprehensive  survey  of  the  part  of  Rumania  as  seen  through  Rumanian  eyes,  it  has 
significance  not  only  for  the  past,  but  for  the  future. — ED. 


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